Tissue Doppler in Ischemic Heart Disease

Tissue Doppler Echocardiography was introduced in the 1960s (Yoshida et al., 1961), and enabled the quantitative assessment of myocardial motion and deformation. The wide use of tissue Doppler as a research tool halted, however, until the early 1990s (Hatle & Sutherland, 2000). Tissue Doppler is now available for high frame rates, wide sector angles and in combination with 2-dimiensional data acquisition. Although widely used in cardiovascular research, the clinical use is limited, probably due to the time consumption associated with special imaging protocols and tedious post processing. Nevertheless, tissue Doppler echocardiography has contributed to most of the available knowledge on the pathophysiology involved in myocardial contraction deficiency. The experienced cardiologist can easily identify large myocardial infarcts by visual analysis of echocardiograms, but identification of a small MI may be challenging due to the modest changes in tissue properties. In ischemic tissue, the contractility is reduced and reduced deformation and deformation rate is observed. Due to differences in contractility among ischemic and adjacent healthy myocardium, the ischemic myocardium has a characteristic deformation pattern with stretch in early systole, reduced systolic shortening, and a delayed (postsystolic) shortening when the ventricular pressure decays. This early stretch and post systolic shortening pattern has been described both experimentally (Edvardsen, T. et al., 2002; Skulstad et al., 2002) and clinically (Gjesdal et al., 2008; Jamal et al., 1999; Voigt et al., 2004).